Amnesia, o.eneral and verbal, weak ness and indistinctness of speech, irri tability, fretfulness, and hypochondria, sometimes reaching to melancholia and suicidal tendencies, are sometimes wit nessed. _Mental aberration is suggested by many petty acts which the patient in his normal state would not have per petrated. Indeed, he may become tyran nical, envious, jealous, and even cruel. Curious perversions of mental activity are witnessed, mental pictures and vari ous thoughts succeeding one another with rapidity, while a name, a sentence, a time, etc., will for hours and even days recur constantly to the patient's mind.
Again, he may constantly be dreading falls, especially when near an open space, such as the top of a staircase, or experi ence a sense of suffocation upon the least excitement or unusual incident of every-day life. The sudden appearance of a stranger or any unusual incident of daily life may thus excite intense fear and give rise to dangerous manifesta tions, especially when an organic cardiac disorder is present.
Pain along the spine accompanied by localized spinal tenderness is often com plained of. Lumbago and various mus cular pains suggesting rheumatism are frequent. In cases in which spinal symptoms predominate there is also marked muscular weakness,—a symptom to which Charcot attached much impor tance and frequently associated with tremor,—and sometimes disturbances of co-ordination, the presence of locomotor ataxia being suggested. General paresis may also be simulated; indeed, when there is a history of syphilis the differ ential diagnosis sometimes becomes diffi cult.
Syphilitic neurasthenia occurs very frequently in the course of syphilis, first showing itself in the secondary period, toward the fourth or fifth month, espe cially in women.
Neurasthenia appearing at the tertiary period is less common, sometimes ac companying the tertiary symptoms and sometimes appearing alone. The abor tive form is the most painful, the most persistent, and the most often unrecog nized. The principal features of the headache, which is the only symptom, are its long duration and the cerebral disturbance, which is greater than the real pain. It is diurnal. and thus allows the patient to sleep calmly at night. The complete form of tertiary neuras thenia is a reproduction of the picture of irritable debility of Beard. Fournier (Gaz. des H6p., Sept. 5, '93).
llypertesthesia of certain regions of the skin (Valleix's points) is sometimes noticed. Formications, evanescent sen
sations of localized heat and cold, are occasionally complained of, though these sensations may be general, as are also profuse sweating and the flushes of heat so frequently met with during the meno pause.
The name neurasthenic spine is used to designate those painful affections of the spine in which the subjective symp toms are out of proportion to the objec tive signs and in which no organic dis ease can be found to exist.
The symptoms of the condition vary very much in severity, but compara tively little in type. The slightest grade is shown by backache, increased by exer tion and physical or mental fatigue. Sensitive spots are present near the spinous processes in different regions of the spine. Sensitiveness of the skin and certain muscles may be present. The pain is increased by motion and jar, and. as a rule, persists for many hours after the cause of it has stopped.
The severest type is repre.sented by a eondition in which the patient is unable to sit erect on account of similar symp toms of severe grade. Snell is the spinal invalid.
11etween the extremes lie cases of every degree of severity. In the severe cases of long standing some impairment of motion is likely to come on, and lateral deviation of the tltine to a slight degree may be present. In most eases, especially in the severer ones, the pa tients present some of the general symp toms which would be classified as neu rasthenic or hysterical. The condition is almost invariably chronic, and with out treatment its tendency is to remain stationary or to grow WOTSC. F. W. Lovett (Amer. Medicine, Nov. 30, 1901).
-Vertigo is often complained of; in some cases it is almost continuous and characterized by exacerbations, during which the patient may fall and suffer injury. Hysterical manifestations are frequent, especially in women, though true hysteria be absent.
Irregular action of the heart, palpita tion, is usually noted, the pulse some times being very rapid; apprehension, pain, and general distress in the cardiac region often result, increased by the least excitement, anxiety, or fit of temper. Throbbing of the arteries, including the peripheral arterioles and even at times the capillaries of the nails, may be nessed, the veins, at times, taking part in the manifestation. Still, the ties may be quite cold, the patient quiring heavy clothing. to feel at all com fortable.